Development and Validation of a Biochemical Correction Model for Accurate HbA1c Interpretation in Iron-Deficient Patients with Type 2 Diabetes Mellitus

Authors

• Ban Adnan Hatem Al-Abadi, Department of Chemistry, College of Science, University of Al-Qadisiyah, IraqFollow
• Farah J. Hasan Alhnon, Pharmaceutical chemistry Branch, College of Pharmacy, Al-Muthanna University, Al-Muthanna, Al_Samawa, 66001, IraqFollow
• Zainab A. H. Alebady, Department of Laboratory and Clinical Science, College of Pharmacy, University of Al-Qadisiyah, IraqFollow

Article Type

Article

Abstract

Hemoglobin A1c (HbA1c) is the most important biomarker for measuring long-term glycemia. HbA1c has shown significant reliability, but it is not free of limitations. Conditions that interfere with red blood cells' life span, including iron deficiency anemia (IDA), may affect HbA1c reliability and interpretation. The study aimed at investigating the effect of iron deficiency on HbA1c reliability and developing a biochemical correction model that would help better interpret HbA1c levels in patients with T2DM.
The study employed a cross-sectional analytical approach on three study groups (healthy controls, patients with T2DM, and patients with T2DM with IDA). The study involved determining the concentrations of HbA1c, fasting plasma glucose (FPG), ferritin, serum iron, total iron binding capacity (TIBC), hemoglobin (Hb), and red cell distribution width (RDW). Linear regression analysis was applied to the data from patients with T2DM in order to build the model for determining the relationship between HbA1c and FPG. The resulted model was then used to estimate the expected values of HbA1c in patients with T2DM with concurrent IDA.
HbA1c levels were considerably higher in both diabetic groups compared to the control group, although the iron levels differed in the T2DM+IDA group. Regression study results showed the strong relationship between HbA1c and FPG in the T2DM group (R² = 0.967, p < 0.001). The correction model showed that the actual HbA1c values were significantly greater than the expected values, 0.39 ± 0.27%.
The observed results suggest that iron shortage may add a clinically important streak of positivity in HbA1c assessment. The model put forward offers a biochemical strategy for HbA1c overestimation detection that may lead to better assessment of glycemic status in patients suffering from T2DM and iron deficiency anemia at the same time.

Keywords

Type 2 diabetes mellitus, Hemoglobin A1c, Iron deficiency anemia, Glycemic assessment, HbA1c bias, Biochemical correction model

Recommended Citation

Al-Abadi, Ban Adnan Hatem; Alhnon, Farah J. Hasan; and Alebady, Zainab A. H. (2026) "Development and Validation of a Biochemical Correction Model for Accurate HbA1c Interpretation in Iron-Deficient Patients with Type 2 Diabetes Mellitus," Muthanna Medical Journal: Vol. 13: Iss. 4, Article 6.
Available at: https://muthmj.mu.edu.iq/journal/vol13/iss4/6

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This work is licensed under a Creative Commons Attribution 4.0 International License.